HHS health rules no balm for states

Sure, the Obama administration is dumping piles of Affordable Care Act rules in everyone’s laps now. The danger, though, is that the rules have been held up so long that the states’ insurance commissioners — even the ones that want to implement the law — may have trouble making up for lost time.

That’s the word from the National Association of Insurance Commissioners meeting near Washington, D.C., last week, where commissioners from around the country told POLITICO that the Department of Health and Human Services has left large holes in its guidance for states building insurance exchanges — online marketplaces for individuals to access subsidized insurance plans.

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But that was before Friday’s regulation dump, which gave health care stakeholders hundreds of pages of guidance on everything from the health exchanges to the multistate plans that are the heath care law’s replacement for the “public option” so many liberals wanted.

Friday’s new rules included a 373-page HHS regulation that covers risk adjustment in the exchanges, cost-sharing limits and user fees for the federal exchanges; a 122-page Office of Personnel Management rule that spells out the guidelines for the Multi-State Plan Program; and the Internal Revenue Service put out a 42-page rule on the Medicare payroll tax that will be charged to high-income earners to help pay for the law.

But the sudden deluge of regulations doesn’t change the fact that insurance commissioners have been kept waiting for months, and they say the delays have made their jobs significantly harder.

Until now, most of the loudest complaints about the lack of guidance on the Affordable Care Act came from Republican governors. But at the insurance commissioners’ conference this week, the officials in the trenches implementing the law — even in states that have been its strongest supporters — quietly expressed the same concerns.

Commissioners from Democrat-led states that have rushed to implement exchanges say they’ve been in a holding pattern awaiting word from the Obama administration. And the things they want out of the regulations — especially the technical details they want about federal exchanges — aren’t likely to be totally resolved by the new rules released Friday.

“We’re still very much depending on getting further guidance from HHS. There are still some major gaps,” said Washington State Insurance Commissioner Mike Kreidler, whose state has long pursued its own exchange. “The timetable that we have is going to be a real challenge. … We’re still plowing ahead but without some of this critical guidance from the federal government, it’s going to be very difficult.”